Articles: general-anesthesia.
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Anasth Intensivther Notfallmed · Oct 1990
[The effect of positive end expiratory pressure on the blood flow velocity in the basal cerebral arteries during general anesthesia].
The effects of incremental positive end-expiratory pressure (PEEP) on middle cerebral artery (MCA) blood flow velocity and pulsatility index were studied in 20 patients scheduled for minor elective surgery. Transcranial Doppler sonography (TCD) was used to measure systolic (Vsyst) and mean flow velocity (Vmean) and the pulsatility index (PI). Heart rate (HR), mean arterial blood pressure (MAP), end-tidal CO2(PetCO2) and TCD parameters were recorded at control (PEEP = O) and following PEEP of 5 cm H2O, 10 cm H2O and 15 cm H2O for a period of 5 minutes for each PEEP level. ⋯ PI increased stepwise in response to each PEEP level. MAP decreased with PEEP 10 and 15 while HR and PetCO2 remained constant over time. These data suggest that PEEP-induced decreases in MCA blood flow velocity may represent decreases in CBF due to impairment of the intracranial venous flow if the diameter of the insonated vascular segment remains constant.
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The esophageal stethoscope is used often during anesthesia to monitor ventilation and cardiac function. Deficiencies in observer vigilance may limit the effectiveness of this monitoring instrument. The aim of this study was to determine how long it took for an observer to detect a surreptitiously occluded monaural esophageal stethoscope in the setting of clinical anesthesia. ⋯ However, 13% of detections were delayed for more than 60 seconds, and 2.3% for more than 240 seconds. While anesthesia personnel using an esophageal stethoscope could detect most stethoscope occlusions, failure to appreciate such episodes occurred in a small but significant number of cases. This suggests that the esophageal stethoscope has some definite limitations as a continuous monitor and that other monitoring techniques, such as oximetry, capnography, and ventilator disconnect alarms, as well as visual/tactile inspection of the patient, should be used as well.
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British dental journal · Sep 1990
A survey of general anaesthesia and sedation in dental practice in two cities.
Using a postal questionnaire, the use of general anaesthesia and sedation in general dental practice in two cities over a 4-week period was investigated. Questionnaires were sent to a random sample of one in five dental practitioners in Bristol and Sheffield, and an 82% response rate was attained. More practices in Sheffield administered general anaesthesia than those in Bristol. ⋯ Equipment and facilities have improved since a larger survey was described in 1976, but the use and availability of monitoring equipment has changed little since then. The results reflect the decline in the use of general anaesthesia in dental practice seen nationally. The survey provides an insight into the current anaesthetic services provided in general dental practice in two cities, both of which contain dental hospitals, and provides a basis for the design of a protocol for a further national survey.
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A caudal epidural catheter was inserted in 20 premature, high risk infants for abdominal or thoracic surgery under combined caudal epidural and general anaesthesia. Epidurography was used to confirm the position of the catheter which was found to be misplaced in three patients. The catheter penetrated the dura in one case, in another the tip was located in an epidural vessel and in the third the catheter was seen to be curled up within the epidural space. It was concluded that epidurographic control is essential with this method of anaesthesia in very small infants, in whom it was found to provide considerable advantages despite serious risks.